HMO
What is the HMO basic covered benefit for a Cerec crown on an anterior tooth?
PFM or Porcelain Fused to Metal crown?
True or False: If a PPO states on the DE form a code is not paid but it is on the fee schedule, the office may charge the patient a UCR fee.
False.
Who does the provider complete a meet and greet with?
Every new patient.
What document must be reference when coordinating for scaling and root planing?
Hygiene Maximizer
Who must an HMO patient be assigned to when seeing a specialist?
The referring provider
How do we determine where an out of network check will be sent?
Out of Network Maximizer
What is the #1 purpose of the front office?
To get patients into the practice
What are the 3 C's?
Choices, Connection, Commitment
True or False: HMOs have frequency and replacement limitations.
How do you explain a waiting period to a patient?
The insurance will not pay toward a procedure from a certain category until a specific date or time has elapsed after the plan effective date.
Explain the $59 dollar special.
$59 special includes exam, x-rays, and a hygiene procedure. $59 gets posted to hygiene.
What does ACCT stand for?
Awareness, Consequences, Concern, Treatment
What is the difference between a plan visit and an office visit?
Plan visit is $5-$10 that we can charge patients on every visit. Office visit is when patient is seeing a provider for anything outside of an exam ex discuss treatment options.
What is required to go at the bottom of an FA for PPOs per insurance requirements?
Basic covered benefit are required on a PPO estimate involving any upgraded procedure or any Cerec CAD/CAM restoration.
What is a paid benefit?
A paid benefit is the amount a PPO carrier will pay toward a specific treatment. Utilize the PPO maximizer.
What does OFC measure?
Measures active aMMP-8 or the progression of collagen breakdown.